COVID 19 Staff Screening tool

Please fill out the form below each morning before coming into any Cataraqui Conservation Workplace. If you have any of the symptoms listed stay home and self-isolate right away. Call you health care provider or go to an assessment centre to find out if you need a COVID 19 test.

COVID Screening Tool - Staff
Do you have any of the following symptoms? *
Does anyone in your immediate household have any of the above symptoms?
Exposure History (check all that apply): *

If you have checked any boxes other than “none of the above” or, if you have checked "yes", do not enter the workplace and notify your supervisor. Go home, self-isolate, follow public health guidelines, and keep your supervisor up to date on your status.

Accuracy of Information *
Collection of Information *